Study for Rural Innovations in the Delivery of Exercise

Adapting an Evidence-Based Exercise Program for Remote Delivery to Rural Older Adults

: Falls are the primary cause of injury and a leading cause of disability and mortality among older adults. Risk factors for falling are common among older adults with knee osteoarthritis (OA) - a highly prevalent condition. Physical exercise is consistently the most efficacious intervention for preventing falls in older adults. However, access to these programs is severely limited in rural settings. Considering that rural communities have a higher disease burden and higher proportion of older adults than non-rural areas, there is a critical need to (1) adapt evidence-based exercise programs for remote delivery to increase access for rural older adults and (2) develop pathways to implement exercise programs in rural health care systems that consistently reach and engage patients with knee OA. Accordingly, the proposed project aims to refine a protocol for remote delivery of Enhance Fitness (EF). EF is an evidence-based, group exercise program involving strength, endurance, and balance training that is recommended for falls prevention and OA management

Inclusion Criteria:

• Community-dwelling
• English-speaking
• Physician diagnosed knee osteoarthritis
• Knee pain that occurs almost daily for at least the past 3 months and is moderate to severe in intensity
• Knee pain-related difficulty with walking or climbing stairs
• resident of a rural county

Exclusion Criteria:

• cognitive impairment determined by a Mini Montreal Cognitive Assessment score of <11
• any of the following in the past 6 months: cancer requiring treatment (except for non- melanoma skin cancer), heart attack, stroke, hip fracture, hip/knee replacement, spinal surgery, heart surgery, deep vein thrombosis, or pulmonary embolus; and temporary exclusions
• hospitalization within the last month
• ≥3 falls within the past month